JOHNSTON & JOHNSTON, Plaintiff-Appellee v. CONSECO LIFE INSURANCE COMPANY, Defendant-Appellant.
No. 13-30010.
United States Court of Appeals, Fifth Circuit.
Oct. 17, 2013.
555
AFFIRMED.
Scott Nikolaus Hensgens, Attorney, Breazeale, Sachse & Wilson, L.L.P., Baton Rouge, LA, Jason Allen Walters (argued), Bradley Arant Boult Cummings, L.L.P., Birmingham, AL, for Defendant-Appellant.
Dana Livingston, Susan Schlesinger Vance, Alexander Dubose & Townsend, L.L.P., Austin, TX, for Amicus Curiae American Council of Life Insurers.
Before STEWART, Chief Judge, and KING and PRADO, Circuit Judges.
CAROLYN DINEEN KING, Circuit Judge:
Conseco Life Insurance Company’s predecessor issued a flexible premium life insurance policy to Johnston & Johnston on the life of Mary Ann D. Johnston in 1988. The Policy’s cash surrender value dropped below zero dollars in December 2010, causing it to enter a sixty-one-day grace period. The Policy terminated in February 2011, after Johnston & Johnston failed to make any payments on the Policy during the grace period. Ms. Johnston died in August 2012. The key question is whether any of the several notices Conseco Life Insurance Company sent to Johnston & Johnston satisfied the requirements of
I. FACTUAL AND PROCEDURAL BACKGROUND
On April 12, 1988, Plaintiff-Appellee Johnston & Johnston (“J & J”) purchased an insurance policy from Philadelphia Life Insurance Company on the life of Mary
The Policy was a “flexible premium adjustable life insurance plan.” Unlike a term or whole life insurance policy, which requires periodic premium payments to maintain coverage, a flexible premium policy does not have scheduled premium due dates. Rather, the policyholder can change both the amount and the frequency of premium payments. See, e.g.,
Under the terms of the Policy, J & J chose the amount and frequency of its premium payments.1 J & J elected to receive annual notices in the amount of $32,451.00, for the so-called “planned periodic premium.” However, because the cost of insurance increased each year, a single annual payment of $32,451.00 became insufficient to cover the cost of insurance and maintain the Policy, requiring J & J to make more frequent payments by the mid-2000s.
The Policy had a cash value.2 It provided that it would remain in effect so long as its cash surrender value—the amount of money the insured could receive by surrendering or redeeming the Policy3—remained sufficient to cover the Policy’s costs for the next month.4 These costs,
With J & J paying premiums only on an intermittent basis, but deductions coming on a monthly basis, it was possible that, at some point, the Policy’s cash value might not be sufficient to cover deductions for the next month. The Policy addressed such a scenario:
At some future time, the policy cash value less indebtedness may not cover the next monthly deduction. In such a situation, the policy will enter the grace period and will terminate at the end of that period if sufficient premium to cover the monthly deduction is not paid.
The Policy’s grace period section provided, in relevant part:
If the cash surrender value on a monthly anniversary day will not cover the next monthly deduction, a grace period of 61 days from such monthly anniversary day will be allowed to pay a premium that will cover the monthly deduction. The Company will send written notice that the policy will lapse 30 days before the end of the grace period to the owner’s last address shown in the Company’s rec[or]ds and to any assignee of record if the premium is not paid.... If the insured dies during the grace period, any past due monthly deductions will be deducted from the proceeds. The policy will remain in force during the grace period, unless surrendered.
As per the grace period provision, failure to pay the planned periodic premium—the $32,451.00 that J & J elected to pay annually—would not affect coverage unless, on a monthly anniversary day,6 the cash surrender value of the Policy was so low that the next monthly deduction would cause the value to drop below zero dollars. For example, if the cash surrender value of a policy was $10,000 on April 5, and the monthly costs totaled $8,000 and would be deducted from the policy on April 12, then as of April 12, the cash surrender value would no longer be sufficient to cover the monthly costs for the next month, May, and the policy would enter a sixty-one-day grace period.
Separately, J & J was a class member in a class action settlement of a case against Conseco in federal district court in California. Pursuant to J & J’s rights as a class member, if the Policy terminated, J & J was entitled to a “death benefit extension period” after the grace period ended. This period would provide coverage to J & J for the Policy’s $1 million face amount for an additional 183 days following termination of the Policy.7 Once the death benefit extension period began, J & J would not be able to make any premium payments on the Policy, since the Policy would no longer be in effect at that point.
The April 13, 2010 annual policyholder statement, the last available, informed J & J that the Policy would terminate on June 12, 2010, if J & J made no further contribution. J & J made a payment sufficient to maintain the Policy. However, the Policy entered a grace period a few months later, on September 12, 2010. Conseco notified J & J that the grace period would expire if J & J did not pay $38,778.46 before November 12, 2010. J & J paid this amount on October 6, 2010, preventing the Policy from reentering a grace period until December 12, 2010.8
Separate from the September 12 grace period notification, on September 21, 2010, Conseco sent J & J a planned periodic premium notice, informing J & J that a premium of $32,451.00 would be due on October 12, 2010.9
On December 12, 2010, Conseco sent J & J a notice that the Policy had again entered a grace period as of that date. According to the December 12, 2010 grace notice, J & J was required to pay $28,794.14 by February 11, 2011, to avoid termination of coverage. Thus, the notice set out a specific amount necessary to maintain the Policy, rather than the planned periodic payment amount of $32,451.00. On January 6, 2011—thirty-six days before February 11—Conseco sent J & J a second grace notice, again stating that J & J would need to pay $28,794.14 by February 11, 2011, in order to avoid termination of coverage.
J & J did not make a payment on the Policy during this period of time. The grace period expired on February 11, 2011,
J & J’s accountant, Ralph Speirs, Jr., was out of the office due to illness during the grace notice periods, and he did not review the grace notices until February 13, 2011, a Sunday. He called Conseco on February 14, seeking to pay the amount set out in the notices. A Conseco representative informed Mr. Speirs that “it was too late to pay the premiums,” but that J & J could apply for reinstatement of the Policy.
J & J applied for reinstatement of the Policy on August 25, 2011. Conseco sent a notice on September 12, 2011, to inform J & J that the death benefit extension period had terminated as of that date. Conseco refused J & J’s reinstatement application on September 15, 2011, “[d]ue to the evaluation of our underwriting department” and “due to Ms. Johnston’s medical history.”
Between the Policy’s inception in 1988 and its termination in 2011, J & J paid $1,233,195.97 in policy contributions. The Policy entered the grace period a total of twenty-two times over the course of its life.
J & J filed suit in federal district court on June 7, 2012, seeking declaratory relief and specific performance. J & J argued that Conseco’s notices violated
Conseco moved to dismiss the complaint or, in the alternative, for summary judgment. It principally argued that the relevant date under
On October 11, 2012, the district court: (1) denied Conseco’s motion to dismiss the complaint or, in the alternative, for summary judgment; (2) granted J & J’s motion for summary judgment; and (3) entered judgment in favor of J & J. Departing from both parties’ arguments, the court held that the operative due date for
Subsequently, Conseco filed a Rule 59(e) motion to alter or amend the judgment, arguing that the district court erred in construing December 12, 2010, as the operative due date for
The district court denied Conseco’s motion, concluding, inter alia, that Conseco was simply reasserting arguments it had made in its motion to dismiss. The court further stated that if the due date had been February 11, 2011, as Conseco contended, then Conseco still would not prevail because Conseco failed to provide an additional thirty-day grace period, as required by Regulation 36, promulgated by the Louisiana Insurance Commissioner.
The court reasoned that one of the Policy’s clauses, “The Company will send written notice that the policy will lapse 30 days before the end of the grace period,” redefined “lapse” as the end of the grace period, rather than when the cash value equals zero dollars. Because lapse was the end of the grace period, the court reasoned that Regulation 36 required Conseco to provide an additional thirty-day grace period after the sixty-one-day grace period ended.
Conseco timely appealed to this court, seeking review of both the district court’s grant of summary judgment to J & J and the court’s denial of Conseco’s Rule 59(e) motion.11
II. STANDARD OF REVIEW
We review de novo a grant of summary judgment, applying the same standard as the district court. First Am. Title Ins. Co. v. Cont’l Cas. Co., 709 F.3d 1170, 1173 (5th Cir.2013). Summary judgment is appropriate “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The court “view[s] all evidence in the light most favorable to the nonmoving party and draw[s] all reasonable inferences in that party’s favor.” In re Katrina Canal Breaches Litig., 495 F.3d 191, 205-06 (5th Cir.2007).
“A federal court sitting in diversity applies the substantive law of the forum state. A district court’s determination of state law is reviewed de novo.” Learmonth v. Sears, Roebuck & Co., 710 F.3d 249, 258 (5th Cir.2013) (internal citations omitted). “If a state’s high court has not spoken on a state-law issue, we defer to intermediate state appellate court decisions, unless convinced by other persuasive data that the higher court of the state would decide otherwise.” Id. (citation and quotation marks omitted). “In making an Erie-guess in the absence of explicit guidance from the state courts, we must attempt to predict state law, not to create or modify it.” Id. (citation and quotation marks omitted).
Under Louisiana law, “[t]he fundamental question in all cases of statutory construction is legislative intent and the reasons that prompted the legislature to enact the law.” SWAT 24 Shreveport Bossier, Inc. v. Bond, 808 So.2d 294, 302 (La.2001). “When a law is clear and unambiguous and its application does not lead to absurd consequences, it shall be applied as written, with no further interpretation made in search of the legislative intent.” Id. (citing
III. APPLICABLE LAW
The parties’ dispute centers on a provision of the Louisiana Insurance Code,
A. No life insurer shall within one year after default in payment of any premium ... declare forfeited or lapsed any policy issued or renewed, and not issued upon the payment of monthly or weekly premiums or for a term of one year or less, for nonpayment when due of any premium ... or any portion thereof required by the terms of the policy to be paid, unless a written or printed notice shall have been duly addressed and mailed to the owner of the policy ... at least fifteen and not more than forty-five days prior to the date when the same is payable. Such notice shall state both of the following:
(1) The amount of such premium ... or portion thereof due on such policy.
(2) The place where it shall be paid and the person to whom the same is payable.
B. No policy shall be forfeited or declared forfeited or lapsed until the expiration of thirty days after the mailing of such notice. Any payment demanded by the notice and made within the time limit shall be fully compliant with the requirements of the policy in respect to the time of the payment.
Under Louisiana law, a “premium” means:
[A]ll sums charged, received, or deposited as consideration for the purchase or continuance of insurance for a definitely stated term, and shall include any assessment, membership, policy, survey, inspection, service or similar fee or charge made by an insurer as a part of the consideration for the purchase or continuance of insurance.
Regulation 36, codified in Title 37 of the Louisiana Administrative Code, §§ 8501-8517, “supplements] existing regulations on life insurance policies in order to accommodate the development and issuance of universal life insurance plans,”
a. The policy shall provide for written notice to be sent to the policyowner’s last known address at least thirty days prior to termination of coverage.
b. A flexible premium policy shall provide for a grace period of at least thirty days (or as required by state statute) after lapse. Unless otherwise defined in the policy, lapse shall occur on that date on which the net cash surrender value first equals zero.
The provider of a flexible premium policy must give the policyholder annual reports on the policy’s status.
IV. DISCUSSION
The critical question in this case is when the insurance premium necessary to maintain the Policy was “payable” under
We conclude that the district court erred in finding that December 12, 2010, is the operative date for
Conseco’s January 6, 2011 notice satisfied the requirements of
The language of
The parties do not dispute that
Nonetheless, the language of
The terms “payable” and “due” are not defined in
We must next determine if, in the flexible premium context, required to be paid means the date the policyholder was required to pay in order to maintain a positive cash value for a policy (i.e., December 12, 2010), or the date the policyholder was required to pay in order to avoid a policy’s termination (i.e., February 11, 2011). This inquiry is likewise complicated by the inapplicability of the concept of due dates in the context of flexible premiums. With a flexible premium policy, an insured might make a payment once every year, or even once every several years, which would be acceptable so long as the cash value remained sufficient to maintain the policy.18
The language of
J & J argues that premiums were due on December 12, 2010, because that is when “the policy lacked sufficient value to maintain coverage and lapsed.” To keep a policy in force, J & J contends, a payment must be made at the time the cash surrender value drops below zero dollars.19 We disagree. The Policy merely entered a grace period on December 12, 2010—as it had done more than twenty times before. The Policy did not terminate for nonpayment of premiums until February 11, 2011.
J & J contends that because an insurer sends a grace notice during a grace period, and a grace period by definition only begins after a premium is past due, then the premiums here were “due” on December 12, 2010. To the contrary, Turner, which we find compelling, indicates that a grace notice, sent during a grace period, can satisfy
J & J cites Boring to support the proposition that “payable,” as used in
This argument is unpersuasive, and Boring is inapplicable. The policy in Boring called for semi-annual premiums with set due dates, whereas the Policy at issue is a flexible premium policy with no premium due dates. As such, Boring offers no guidance on how to interpret the “due dates” here. Additionally, we find it more persuasive to consider the “premium” “payable” and “due” on February 11, 2011, when the Policy would terminate without another payment, rather than December 12, 2010.
We find Time Ins. Co. v. Vick, 250 Ill.App.3d 465, 190 Ill.Dec. 48, 620 N.E.2d 1309, 1315-17 (1993), on which the district court relied, likewise distinguishable.22
Regulation 36 also supports our conclusion. By promulgating Regulation 36, which outlines notice requirements for flexible premium policies, the Louisiana Insurance Commissioner provided guidance on applying
There is no question that Conseco complied with these requirements. J & J was afforded each of these protections. Unfortunately, J & J missed each opportunity to pay the premium necessary to maintain the Policy. Given Conseco’s compliance with the notice requirements, J & J cannot convincingly claim that Conseco failed to provide it with fair notice.
Thus, our conclusion is consistent with the Louisiana Legislature’s intent in enacting
We note that providing legally adequate notice before the beginning of a grace period is a practical impossibility if a policyholder makes a withdrawal from a policy less than fifteen days before a monthly anniversary day. Although a policyholder seeking to defraud an insurer in this way might not benefit from
Further, requiring the insurer to give yet another notice, prior to the grace period, is unnecessary when the grace notice itself is sufficient to put the insured on notice that the policy will terminate without further payments. The grace notice comes in addition to annual policy reports, as required under Regulation 36, that inform the insured of the policy’s net cash surrender value and alert the insured if that value “will not maintain insurance in force until the end of the next reporting period unless further premium payments are made.”
Additionally, we consider the reasoning of the New York State Insurance Department (NYSID) in reconciling nearly identical statutory and regulatory notice requirements in the flexible premium context, because we find it the type of “persuasive data” that the Louisiana Supreme Court might consider.23 Learmonth, 710 F.3d at 258. NYSID determined that an insurer could satisfy the requirements of New York’s equivalent of both
Finally, we conclude that the Policy did not enter a second grace period following the February 11, 2011 termination date, contrary to the district court’s suggestion in its ruling on Conseco’s Rule 59(e) motion. Regulation 36 does require flexible premium policies to provide a thirty-day grace period after lapse, where “lapse,”
V. CONCLUSION
For the aforementioned reasons, we REVERSE the judgment against Conseco and REMAND for entry of judgment in its favor.
Notes
CASH VALUE
The cash value of this policy is the value of the accumulation account less the surrender charge. The accumulation account on the date of issue will be the initial net premium. Net premium is the gross premium paid less the percentage of premium expense charge shown on a Policy Data Page.
The accumulation account on a monthly anniversary day will be calculated as (a) plus (b) plus (c) minus (d) minus (e) minus (f) where:
(a) is the accumulation account on the preceding monthly anniversary day;
(b) is one month’s interest on item (a);
(c) is the premium paid (less the percentage of premium expense charge during the first policy year) plus interest credited to any premium received since the preceding monthly anniversary day;
(d) is the monthly deduction for the month preceding the monthly anniversary day;
(e) is one month’s interest on item (d);
(f) is the amount of any partial withdrawals.
On any day other than a monthly anniversary day, the accumulation account will be calculated as (a) plus (c) minus (d) minus (f) using the definitions above.
. . . .
CASH SURRENDER VALUE
At any time, the cash surrender value of this policy is:
1. the accumulation account;
2. less any indebtedness on this policy; and
3. less a surrender charge, if any[.]
In the event of withdrawal of a foreign or alien insurer, as provided in [
The fee for the catastrophe or emergency registration shall be as set forth in [
